AB1682 ARE CHANGES IN SELF-REPORTED NSAID DOSE ASSOCIATED WITH MEANINGFUL CHANGES IN PAIN OR OTHER HEALTH OUTCOMES IN RHEUMATIC DISEASES?
Authors: K. Michaud, S. Pedro, N. Goel
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatic disease primary treatment effectiveness research inconsistently addresses confounding effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on pain and inflammation. Further, NSAID comedication use is often captured either as a simplified binary measure (eg, yes/no) or with a more burdensome high level of detail (eg, daily pill dose). <h3>Objectives</h3> Evaluate if moderate complexity items measuring changes in monthly NSAID dose are associated with changes in pain. <h3>Methods</h3> Patient-reported data from 1998-2021 were analyzed from the Forward Databank, a US-based longitudinal rheumatic disease registry, with questionnaires completed every 6 months. Eligible participants with RA or OA reported NSAID use on ≥1 questionnaire and had ≥1 follow-up (FU) questionnaire. NSAID use recorded type of drug, initiation, discontinuation, dose, and frequency by 0-10, 11-20, or &gt;20 days a month. Primary exposure was change in NSAID dose from baseline (increase, no change, decrease). Increase was defined as initiation, increase in frequency, increase in dose, or any combination of the 3; decreases were similarly defined directionally. Primary outcome was change in the pain visual analog scale (VAS, 0-10). Gaussian generalized estimating equations (GEE) models with robust standard errors [SE] were used to assess the association between pain and NSAID change or type of change (increase, decrease). Models were adjusted for demographics, rheumatic disease comorbidity index (RDCI), total joint replacement, other treatments (eg, opioids, disease-modifying antirheumatic drugs), and NSAID type. <h3>Results</h3> A total of 22,445 RA and 5,278 OA patients initiated ≥1 NSAID. Median (IQR) FU time of NSAID exposure was 4.5 (2–9) years for RA and 2.5 (1–5) for OA. Patients with RA vs OA were younger (59 vs 64 years [y]), but similar on other characteristics (male 20% vs 15%, White 96% vs 94%, disease duration 14 vs 16y, and RDCI [1.5 ±1.5 vs 1.7±1.5]). Overall, 24% of RA 6-month observations (∼160700 observations) included an NSAID increase and 18% a decrease; in OA (∼39800 observations), 30% increased and 18% decreased. 70% of RA patients (OA 77%) had an NSAID increase during FU and 69% (OA 67%) decrease. Starting or stopping an NSAID was the most common change (Figure 1). In RA, any NSAID increase was significantly associated with increased pain of 0.15 units (and for any NSAID decrease, decreased pain of 0.06) (Table 1), supported by the statistically significant directional changes in pain for any individual category of NSAID increase or decrease. In OA, any NSAID increase was significantly associated with increased pain of 0.06 units but were not significant for any decrease; only the individual categories of NSAID initiation and increased dose were significantly associated with increased pain and decreased NSAID dose associated with decreased pain. <h3>Conclusion</h3> We quantified the change in pain associated with change in NSAID dose generally, directionally, and by change type. All types were important for an increase in pain, but a decrease in NSAID frequency was more significant than other types for RA. Further work is needed to extend the definition of change by including other confounding treatments, eg. analgesics and opioids, and to understand optimal collection of concomitant medications that may influence trial results, especially in OA. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Kaleb Michaud: None declared, Sofia Pedro: None declared, Niti Goel Shareholder of: UCB shareholder, Employee of: Trialspark employee.